HomeMy WebLinkAboutPermit Electrical 2011-4-4
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Electrical Permit Application
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CITY OF SPRINGFIELD; OREGON. '
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225 Fifth 'Streett Springfield, OR 97477 t PH(541)726-3753 t FAX(541)726-3689
DEPARTMENT USE ONLY
Penn it no,: $.' I ~ 5'J r
Date: t..{ 4- II
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
'lOCAL'GOVERIIIMENT APPROVAG'i
Zoning approval verified? 0 Yes 0 No
, "CATEGOR'{;'OF'CONSTRUCTION';' .'
",. -'-. . - . - - . - .,". - ..
[}I(.'sidential 0 Government 0 Commercial
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Job site address: ,:;
City: ~ ~,-Il
Reference:
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Name:
PROPERTY OWNER
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Phone:
E-mail:
This installation is being made on residential or fann property
owned by me or a me,!,ber of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
'Szrv; .
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E-mail:
CCB license no.:
o411C-
Print name of signing supervisor:
Signature of signing supervisor:
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440-2584-J (9/08/COM)
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,Number' of.inspectio'n'~ per it~m'O Qty. Cost Total
. .', - .'- . ..' - ....., ;..,~;, cost
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Residential, per unit, service included:
1,000 sq: ft. or less (4) $134.00 $
Each additional 500 sq. ft, or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
,Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 63.00 $ (,1
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee;
First branch Circuit (2) $ 55,00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder '!ot inCluded
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a Iimited~energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
;~~Ht*~~~{~~;W~1(:c~~~AP~F!.LiCANT~~US}:\~:;I::~{'{/{~:f:~;',;;1~;!;fi';:::(: "'.,..
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(A) Enter subtotal of above fees &1-
(Minimum Permit Fee $58.00) $
(B) Enter 12% surcharge (.12 x [A]) $ I) ~"
(C) Technology Fee (5% of [A]) $ '1 ,,>
TOTAL fees and surcharges (A through C): $ 1)1'.!.!..~
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541.726.3753
www.ci.springfield.or.us
811-SPR2011-00538
1442 6TH ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000649
lDESCRIP.TION
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
Temp services 200 amps or less
RECORD NO: 811-SPR2011-00538
DATE: 04/04/2011
L1'Ef.M.ENTT'(PE- .
Credit Card
00043
'PA YOR .' CASHIER:CCARPENTER
EVERYDAY ELECTRICAL
SERVICE INC
ACCOUNT-CODE AMOUNT.DUE"
821-00000-215004 7.56
100-00000-425605 3.15
224-00000-426102 63.00
TOTAL DUE: 73.71
,_. - - AMOUNT PAID -r
;COMMENTS
73.71
TOTAL PAID:
73.71